Low Back Pain: Spondylolisthesis

Low back pain
can arise from many conditions, one of which is a mouthful:
spondylolisthesis. The term was coined in 1854 from the Greek words,
“spondylo” for vertebrae and “olisthesis” for slip. These “slips” most
commonly occur in the lower back (90% at L5 and 9% at L4). According to
experts, the most common type of spondylolisthesis is called “isthmic
spondylolisthesis,” which is a condition that includes a defect in the
back part of the vertebra in an area called the pars interarticularis,
which is the part of the vertebra that connects the front half
(vertebral body) to the back half (the posterior arch). This can occur
on one or both sides, with or without a slip or shift forwards, which is
then called spondylolysis. Isthmic spondylolisthesis occurs in about
5-7% of the general population, favoring men over women 3:1. Debate
continues as to whether this occurs as a result of genetic
predisposition caused by environmental factors early in life as noted by
the increased incidence in populations such as Eskimos (30-50%), where
they traditionally carry their young in papooses, vertically loading
their lower spine at a very young age. However, isthmic
spondylolisthesis can occur at anytime in life if a significant backward
bending force occurs that results in a fracture but reportedly, occurs
most frequently between ages 6 and 16 years old.

Often, traumatic
isthmic spondylolisthesis occurs during the adolescent years and in
fact, it is the most common cause of low back pain at this stage of
life. Sports that most commonly cause this type of injury include
gymnastics, football (lineman), weightlifting (from squats or dead
lifts) and diving (from over arching the back). Excessive backward
bending is the force that overloads the back of the vertebra resulting
in afracture sometimes referred to as a stress fracture, which is a
fracture that occurs as a result of repetitive overloading over time,
usually weeks to months.

If the spondylolisthesis lesions do not
heal either by cartilage or by bone replacement, the front half of the
vertebra can slip or slide forwards and become unstable. Fortunately,
most of these heal and become stable and don’t progress. The diagnosis
can be made via a simple x-ray, but to determine the degree of
stability, “stress x-rays” or x-rays taken at endpoints of bending over
and backwards are needed. Sometimes, a bone scan is needed to determine
if it’s a new injury verses an old isthmic spondylolisthesis.

Another
very common type is called degenerative spondylolisthesis, which occurs
in 30% of Caucasian and 60% of African-American woman (3:1 women to
men). This usually occurs at L4 and is more prevalent in aging females.
It is sometimes referred to as “pseudospondylolisthesis” as it does not
include defects in the posterior arch but rather results from a
degeneration of the disk and facet joints. As the disk space narrows,
the vertebra slides forwards. The problem here is that the spinal canal,
where the spinal cord travels, gets crimped or distorted by the forward
sliding vertebra and causes compression of the spinal nerve root(s),
resulting pain and/or numbness in one or both legs. The good news about
spondylolisthesis is that non-surgical approaches, like spinal
manipulation in particular, work well and chiropractic is a logical
treatment approach!

Members of ChiroTrust® have taken “The ChiroTrust Pledge”: “To the best of my ability, I agree to provide my patients convenient, affordable, and mainstream Chiropractic care. I will not use unnecessary long-term treatment plans and/or therapies.”

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This information should not be substituted for medical or chiropractic advice. Any and all health care concerns, decisions, and actions must be done through the advice and counsel of a health care professional who is familiar with your updated medical history.